Cost Analysis With Use of Expandable Cage or Cement in Single level Thoracic Vertebrectomy in Metastasis

Abstract

Study Design: Retrospective case series. Objective: Patient with metastatic cancer frequently require spinal operations for neural decompression and stabilization, most commonly thoracic vertebrectomy with reconstruction. Objective of the study was to assess economic aspects associated with use of cement versus expandable cage in patients with single level thoracic metastatic disease. We also looked at the differences in the clinical, radiological, complications and survival differences to assess non-inferiority of PMMA over cages. Methods: The electronic medical records of patients undergoing single level thoracic vertebrectomy and reconstruction were reviewed. Two groups were made: PMMA and EC. Totals surgical cost, implant costs was analyzed. We also looked at the clinical/ radiological outcome, complication and survival analysis. Results: 96 patients were identified including 70 one-level resections. For 1-level surgeries, Implant costs for use of cement—$75 compared to $9000 for cages. Overall surgical cost was significantly less for PMMA compared to use of EC. No difference was seen in clinical outcome or complication was seen. We noticed significantly better kyphosis correction in the PMMA group. Conclusions: Polymethylmethacrylate cement offers significant cost advantage for reconstruction after thoracic vertebrectomy. It also allows for better kyphosis correction and comparable clinical outcomes and non-inferior to cages.

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

“…They will be used in a separate study to develop evidence-based recommendations for economic evaluations in spine surgery. Finally, a total of 130 clinical cost-effectiveness studies were included 24–153…”

Bone Graft and Bone Graft Substitute Options in Metastatic Spine Surgery

“…21,22 PMMA is most commonly used combined with Steinman pin augmentation, which results in a lower risk of dislodgment. In a recent cost analysis study, Katzir et al 23 found that PMMA reconstruction was associated with implant cost savings of approximately $20 thousand per vertebral body level and reduced overall operation Fig. 1…”

“…26 Additionally, expandable cages carry significantly higher implant costs compared with other reconstruction options such as PMMA. 23…”

“…Despite their widespread use, both structural and expandable cages have been associated with dislodgement, subsidence, and even fracture of adjacent vertebrae 26. Additionally, expandable cages carry significantly higher implant costs compared with other reconstruction options such as PMMA 23…”